Adjusting Medicare capitation payments using prior hospitalization data
Adjusting Medicare capitation payments using prior hospitalization data
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使用之前的住院数据调整医疗保险按人头付费
作者：
A. Ash;F. Porell;L. Gruenberg;E. Sawitz;A. Beiser
提出了健康维护组织报销模式的诊断成本组方法。关于以前住院的诊断信息被用来创建经验性确定的风险组，只使用很少或根本不涉及住院决定的诊断。诊断成本组和其他模型(包括Medicare的当前公式和其他以前使用的模型)使用R2值和预测性能的新指标，测试它们预测未来成本的能力。诊断成本组模型在一系列标准方面表现相对较好，包括管理可行性、对提供者操纵的抵抗力和统计准确性。
The diagnostic cost group approach to a reimbursement model for health maintenance organizations is presented. Diagnostic information about previous hospitalizations is used to create empirically determined risk groups, using only diagnoses involving little or no discretion in the decision to hospitalize. Diagnostic cost group and other models (including Medicare's current formula and other prior-use models) are tested for their ability to predict future costs, using R2 values and new measures of predictive performance. The diagnostic cost group models perform relatively well with respect to a range of criteria, including administrative feasibility, resistance to provider manipulation, and statistical accuracy.